Organization
NIGHT BOAT PLLC
Active
Other names
Madison Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSS N HUGUES D.D.S. (OWNER/PEDIATRIC DENTIST)
(208) 552-5439
Entity
Organization
Contact information
Practice address
859 S YELLOWSTONE HWY STE 1202, REXBURG, ID 83440-6201
(208) 552-5439
(208) 552-5440
Mailing address
859 S YELLOWSTONE HWY STE 1202, REXBURG, ID 83440-6201
(208) 552-5439
(208) 552-5440
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010165079
REGENCE BLUESHIELD OF ID
ID
01
—
6P475
BLUECROSS OF IDAHO
ID
05
—
807793700
—
ID
01
—
9202516
MEDICAID - IDAHO SMILES
—
Enumeration date
03/19/2008
Last updated
02/12/2016
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